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PubMed1983

New drugs--boon or bane? Premedication and intravenous induction agents.

Research on the benzodiazepines has shown that they have certain advantages over the opiates as premedicants. Diazepam, which produces good tranquilization, is well absorbed when given orally though absorption is influenced by other drugs given at the same time. Oral lorazepam leads to more prolonged sedation and amnesia but the final elimination is more rapid. Several new intravenous anaesthetics have been introduced during the last five years but none seems likely to replace thiopental. The theoretical disadvantages of thiopental are offset by its water-solubility, and the use of Cremophor EL in preparations of propanidid, alphaxalone, di-isopropyl phenol and one preparation of diazepam has led to many hypersensitivity reactions. Ketamine is gradually finding its rightful place in anaesthesia but its use is becoming limited to anaesthesia in difficult circumstances. The future concomitant use of other drugs and separation of isomers of ketamine may again broaden its applications. The new water-soluble steroid minaxolone has its own disadvantages, and the water-soluble benzodiazepine midazolam is as unpredictable for induction of anaesthesia as diazepam.

Alfaxalone Alfadolone Mixture↗
PubMed1981

[Control of gastric acidity with cimetidine given as premedication before general anesthesia: efficacy and tolerance].

Cimetidine 400 mg was administered intramuscularly 60 minutes before the beginning of general anaesthesia. The double blind experiment was conducted on 84 patients divided in two groups: cimetidine and control. There was no difference in gastric fluid volume between the two groups during general anaesthesia, but acid secretion decreased significantly in the cimetidine group. Values of pH lower than 2.5 were observed in 33.3 per cent at induction and 34 per cent at recovery in the control group against 14.6 per cent and 0 per cent in the cimetidine group. Clinical tolerance to cimetidine was studied in 100 patients during operation. Cimetidine did not alter pharmacological action of usual anaesthetics. There were no significant changes in cardiovascular and electrocardiographic data.

Anesthesia, General↗
PubMed1993

Nasal ketamine for paediatric premedication.

Ketamine in a dose of 6 mg.kg-1 was nasally administered in 86 healthy children (ASA I and II), aged from two to five years undergoing elective general, urological or plastic surgery, 20 to 40 min before the scheduled surgery time. These children were compared with 62 others, also aged from two to five years, in whom promethazine and meperidine, 1 mg.kg-1 of each, were injected im. Sedation was started as excellent in 48 and as adequate in 19 children in the ketamine group, compared with nine and 12 respectively in Group 2 (P < 0.05), while salivation was similar in both groups. We conclude that nasal ketamine is an alternative to im preanaesthetic sedation administration in children aged from two to five years.

Administration, Intranasal↗
PubMed2001

Oral transmucosal midazolam premedication for preschool children.

PURPOSE: To evaluate the acceptance and effectiveness of 0.2 mg x kg(-1) of oral transmucosal midazolam as a premedicant in infants and preschool children. METHOD: In a randomized, prospective double-blind placebo controlled study, 44 healthy children, between the ages of eight months to six years, presenting for elective surgery were divided in two groups. The medicated group received 0.2 mg x kg(-1) of injectable midazolam mixed with an equal volume of strawberry syrup and the placebo group received plain syrup 0.08 ml x kg(-1). Medications were placed on the anterosuperior aspect of the child's tongue in 3-5 aliquots of 0.2-0.4 ml. A blinded observer assessed the acceptance of the medication by willingness to open the mouth for the next aliquot and the efficacy of the medication was assessed by ease of separation from the parent. RESULTS: Ninety-six percent of the children in the placebo group and 95% in the midazolam group willingly accepted the medication. Separation of children from parents was successful in 95% of the medicated children compared with 59% in the placebo group (P = 0.006). CONCLUSION: Oral midazolam in thick strawberry syrup, administered in small aliquots via the oral transmucosal route was well accepted and proved to be an effective premedicant in infants and preschool children.

Behavior↗
PubMed2006

High levels of impulsivity may contraindicate midazolam premedication in children.

PURPOSE: To investigate the effects of midazolam on emotional reactivity during induction of anesthesia in a pediatric day surgery setting. A secondary purpose was to determine if these effects were influenced by child temperament factors. METHODS: Forty children (age four to six years) scheduled for myringotomy were randomly assigned, in a double blind fashion, to receive either oral midazolam 0.5 mg.kg-1 mixed with acetaminophen suspension or acetaminophen alone. The Emotionality, Activity, Sociability, and Impulsivity (EASI) scale was used as a measure of child temperament. The modified Yale Preoperative Anxiety Scale (m-YPAS), an observer-rated measure of state anxiety, was employed to assess anxiety pre- and post-drug, and also at induction of anesthesia. RESULTS: Children who received midazolam reacted significantly less to induction of anesthesia than did children in the placebo control group, F (1, 38) = 7.46, P = 0.01. A significant positive association was observed between baseline levels of anxiety and observer-rated anxiety at anesthetic induction, but only in the placebo group, r = 0.58, P < 0.01. A significant positive association was observed between levels of impulsivity at baseline and observer-rated anxiety at anesthetic induction, but only in the midazolam group, r = 0.42, P < 0.05. CONCLUSIONS: Midazolam dampened adverse reactivity during anesthetic induction, particularly among children with high baseline levels of anxiety. Baseline level of impulsivity was positively associated with adverse reactions to anesthesia induction in the drug group, but not in the placebo group, suggesting that high levels of trait impulsivity may contraindicate the use of midazolam as a preoperative medication.

Acetaminophen↗
PubMed2004

[Premedication visits. Economizing at the cost of the patient?].

The older the patient, the higher the risk of perioperative cardiac complications. Therefore, patients at risk have to be identified and the appropriate diagnostic or therapeutic measures initiated. The most important factor in this context is whether a planned surgery can be postponed. Several strategies have been developed (e.g. Goldman index, Eagle criteria) and the American Heart Association (AHA/ACC) has produced guidelines concerning perioperative diagnosis and therapy of cardiac risk patients. The common goal of these strategies is always the risk classification of the patient by combining the operative risk and the risk factors of the patient. The further procedure (diagnostic or therapeutic measures) is based on the risk classification. If further invasive therapy proves to be necessary, the determining factor is the period of time for which the operation can be delayed. This appears to be about 3 months but if this is not possible the outcome could be improved with a beta-blocker therapy in advance. A working group from the university hospital in Marburg has developed a strategy for risk classification and further diagnostic and therapeutic measures as outlined in this article.

Adrenergic beta-Antagonists↗
PubMed1993

Comparison of oral triazolam and nitrous oxide with placebo and intravenous diazepam for outpatient premedication.

Triazolam was evaluated as an oral sedative agent for dental outpatients in two studies in the oral surgery model. The first study demonstrated that 0.25 mg of triazolam in combination with nitrous oxide provides therapeutic effects but with a more rapid recovery than a 0.50 mg dose in combination with nitrous oxide. In the second study, triazolam produced a significant anxiolytic effect that was comparable to the effects of diazepam titrated to the usual clinical endpoint (mean dose = 19.3 mg). Less impairment in cognitive-psychomotor impairment and ambulatory function was seen after triazolam in comparison with diazepam. Triazolam appears to be a safe, effective alternative to parenteral sedation with a benzodiazepine for dental outpatients.

Administration, Oral↗